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	Goodbye Conversations Ernest H. Rosenbaum, MD, Isadora R. Rosenbaum, MA and Sabrina Selim, MD

Saying goodbye may be one of the most difficult aspects of dying for both patient and loved ones.

Discussion and implementing ways to assist survivors, as described in the Legacy Project -- by signing living and ethical wills, and by trying to answer difficult questions for relatives, such as What do you think that cancer has done for you, and how has it affected your life? -- can be very supportive to those around the patient. It can also allow them to interact with one another in loving supporting ways that can be a touchstone to help in the grieving process. But there are times when such an approach will not work: the dying person may be denying reality, or may not be interested in or able to have such sensitive discussions.

This type of anticipatory grief session or conversation can cause great anxiety as well as sadness, because it accentuates the loss of life that will soon occur. It also means grieving for the time that will never be spent together and the anger at being denied this precious time. Even so, we have found that it gives great strength to the survivors. It can involve admitting some inadequacies -- for example, that one has not prepared enough to provide well for one's survivors. It can also involve expressing guilt. But an honest approach to the reality of life can be consoling, and the advice that is given can often be helpful and supportive for family and friends.

There is no right time to have such a conversation. Often, though, having it weeks or months before death occurs can help in the anticipatory grief process, as well a lay the foundation for support during the actual after-death grieving. Speaking frankly and setting future standards for one's family's expectations, as well as compassionately discussing and revealing the inadequacies of life, can be very meaningful during this difficult and serious time.

Such a somber experience may help renew faith in beliefs and give a sort of breath of life, not only to the dying person (because it may relieve anxieties) but also to his or her survivors (to whom it may give future strength). This is a recognition of the frailty of life and humanity, but is also an expression of the meaning of one's spirit and philosophy.

Some people hope for a miracle, putting great effort into treatments -- whether conventional or alternative -- only to experience disappointment and depression when those treatments fail. Talking about one's concerns, one's fears and even talking about one's death can be a strengthening experience that gives people a bridge to the future.

The ability to confide one's thoughts which may not have been possible for many years, and also the ability to listen nonjudgementally, can help a dying person acknowledge and reaffirm the feelings of sadness and acceptance, reflecting the resilience of the human spirit and reducing some of the shock, pain and ongoing feelings of loss in the grieving process.

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